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Map of Uganda showing the regions, subregions, and districts where the district stakeholders’ meetings and training of PHC workers were conducted. Adapted from: Uganda Bureau of Statistics (UBOS). In this map, Western region = Western and South Western, Northern = Acholi, West Nile and Lango, Eastern region = East‐central, Elgon, Teso and Karamoja. During the capacity building activities, Acholi, Lango, and Karamoja were zoned as Northern region and North‐western districts zoned with West Nile.
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Background
In 2018, approximately 60,000 Ugandans were estimated to be suffering from cancer. It was also reported that only 5% of cancer patients access cancer care and 77% present with late‐stage cancer coupled with low level of cancer health literacy in the population despite a wide coverage of primary healthcare facilities in Uganda. We aimed t...
Citations
... The figure demonstrates that Nigeria is leading with studies on cancer literacy (Adedimeji et al., 2017;Eguzo & Camazine, 2013;Gabriel et al., 2021a, b); many countries did not publish any study exploring it. Among the 22 studies, most focus on cancer literacy during the treatment phase (N = 11) (Beltrán Ponce et al., 2023;Eguzo & Camazine, 2013;Gabriel et al., 2021b;Kidayi et al., 2023;Omofoye et al., 2024;O'Neil et al., 2024), across the cancer care (Adedimeji et al., 2017;Bowser et al., 2017;Ezenwankwo et al., 2022), five focus on the prevention/early detection phase (Ducray et al., 2021;Gedefaw et al., 2020;Jatho et al., 2020Jatho et al., , 2021Moukam et al., 2021), and one even focuses on the palliative care (Afolabi et al., 2021). All studies reported a low level of cancer literacy, and only three studies document an intervention to improve it (Gabriel et al., 2021a;Jatho et al., 2020;Tilly et al., 2022). ...
It is a verifiable fact that the incidence of cancer is on the rise on a global scale, including in Africa. A high level of cancer literacy is essential for patients, their families, and healthcare professionals to be able to undergo cancer screening, cope more effectively with a diagnosis, adhere to a treatment plan, and manage the disease more successfully. To date, there is a paucity of knowledge regarding cancer literacy on a global scale, and it has never been examined for the African continent as a whole. This chapter aims to illustrate the importance of cancer literacy, define it, and review the various
survey instruments that have been employed in this field. Subsequently, the chapter presents an overview of cancer literacy in Africa, based on existing studies, and discusses the challenges and initiatives at all levels of society to enhance cancer literacy. In conclusion, the chapter presents a discussion of the way forward. The chapter illustrates the critical importance of cancer literacy and the necessity of collaborative initiatives to enhance cancer literacy at the political, organizational, community, and individual levels. This overview chapter and the concrete examples it presents may serve as a source of inspiration for this endeavor.
... It highlights key interventions, lessons learned from other African nations, and international experiences, with a particular focus on the Eastern Cape province of South Africa. Countries like Kenya and Uganda have implemented community health worker programmes to extend the reach of oncology services into rural areas, facilitating early detection and referral for cancer patients [50][51][52]. These programmes leverage local resources and knowledge, reducing geographic barriers to care. ...
Background
The scarcity of oncology specialists poses a significant challenge globally, particularly in regions with limited healthcare resources. This leads to delayed diagnoses and disparities in care. The shortage of oncology services disproportionately affects vulnerable populations, leading to delays in diagnosis, treatment, and poorer outcomes.
Aim
This study investigates the implications of oncology resource scarcity, focusing on South Africa’s Eastern Cape province, aiming to analyse challenges, interventions, and lessons from other countries.
Method
This review study employed a mixed-method research design encompassing an empirical literature review and case study approach. It drew on existing research and data to analyse the impact of oncology resource scarcity on patient care.
Results
Cancer-related mortality in the province remains considerable, with lung cancer emerging as a leading cause, underscoring the need for comprehensive cancer control strategies. Infrastructure disparities between urban and rural areas compound the challenges, with limited access to oncology facilities and specialists in remote regions.
Conclusion
Urgent action is needed to address oncology resource scarcity to improve cancer care outcomes, particularly in underserved regions. Targeted interventions and lessons from other countries can enhance access to quality oncology services and reduce disparities in care.
Contribution
This study’s findings have significant implications for South African health policy, particularly regarding the urgent scarcity of oncology resources. The critical shortage of oncology specialists in underserved areas like the Eastern Cape underscores the necessity for a comprehensive strategy to enhance cancer care.
... Another study from Uganda reported that there is an enormous number of unmet needs for services related to cancer prevention and early diagnosis that should be investigated. 27 Furthermore, Sharma and colleagues 28 recommended increasing cancer awareness, adopting preventive (primary and secondary) measures, timely diagnosis, and treatment, reducing risk factors, and improving capacity building and infrastructure to reduce cancer mortality in African countries. ...
Purpose
The purpose of this study was to (1) identify the priorities of oncology research in the Gaza Strip; (2) explore the needs for improving oncology research in the Gaza Strip, Palestine.
Participants and Methods
A qualitative approach for data collection was used in this study. After obtaining the ethical approvals to conduct this study, a sample of 42 health-care providers who are involved in providing oncology care and research in the Gaza Strip were included in this study. Data were collected by the researchers through seven focus groups. Thematic coding was used for data analysis. Two main themes and several sub-themes were extracted during the data analysis.
Results
The two main themes extracted from data analysis were research priorities and research needs. Participants identified several priorities in relation to oncology research that are assessing for cancer awareness, cancer prevention, exploring and finding new molecular biomarkers, screening for germ-line mutations related to the most common cancers, determining genetic and environmental risk factors for developing cancer, and exploring and testing new cancer therapies. Concerning research needs, participants identified several needs to enhance oncology research, which are financial needs, need for training, availability of data, creation of interdisciplinary research teams, and transforming in vitro studies to in vivo.
Conclusion
Well-designed studies will certainly help to identify the priorities and needs to improve oncology research in the Gaza Strip, which is considered one of the most important steps to help push these priorities onto the agenda of health policymakers. Therefore, they will work to set goals and design policies and programs aiming to reduce incidence and prevalence rates of cancer in the Gaza Strip, promote early detection of cancer, improve prognosis, and reduce mortality related to cancer.
... In Ghana the evaluation secured complete national funding for the management of four index cancers [2]. Independent from the GICC, Uganda has evaluated the health systems including the needs of childhood cancer [24]. Ethiopia reported a childhood cancer incidence of 8 per 1000 children [25]; that the major reasons for abandonment of care were cost of treatment and extended travelling times to treatment facilities [26]. ...
We present a literature search of African initiatives based on Global Initiative for Childhood Cancer (GICC) core projects. We call on governments to address childhood cancer care with transparent reporting and effective use of available resources. We note that collaboration and capacity building are key to sustainable improvement of health outcomes in Africa.
... Building workforce capacity to deliver cervical cancer screening services remains a challenge globally, [16][17][18] where only a limited number of physicians and nurses are appropriately trained to provide primary health care in rural and other medically underserved areas. Limited access to academic public health and medicine further reduces the ability of this workforce to develop or improve the competencies needed to deliver cancer prevention services in an effective and efficient manner. ...
In 2020, the highest rates of cervical cancer incidence and mortality were reported in Asian and African regions of the world. Across the globe, growing evidence confirms cancer disparities among racial and ethnic minorities, low socioeconomic status groups, sexual and gender minorities, uninsured individuals, and rural residents. Recognition of these stark disparities has led to increased global efforts for improving screening rates overall and, in medically underserved populations, highlighting the urgent need for research to inform the successful implementation of cervical cancer screening. Implementation science, defined as the study of methods to promote the integration of research evidence into health care practice, is well-suited to address this challenge. With a multilevel, implementation focus, we present key research directions that can help address cancer disparities in resource-limited settings. First, we describe several global feasibility studies that acknowledge the effectiveness of self-sampling as a strategy to improve screening coverage. Second, we highlight Project ECHO as a strategy to improve providers’ knowledge through an extended virtual learning community, thereby building capacity for health care settings to deliver screening. Third, we consider community health workers, who are a cornerstone of implementing public health interventions in global communities. Finally, we see tremendous learning opportunities that use contextually relevant strategies to advance the science of community engagement and adaptations that could further enhance the uptake of screening in resource-limited settings. These opportunities provide future directions for bidirectional exchange of knowledge between local and global resource-limited settings to advance implementation science and address disparities. Ethn Dis. 2022; 32(4):269-274; doi:10.18865/ed.32.4.269
Cancer remains a leading cause of mortality in Nigeria, with increasing incidence rates driven by factors such as urbanization, aging, and lifestyle changes. Despite efforts to improve cancer care, barriers such as late diagnosis, inadequate healthcare infrastructure, and limited public awareness hinder effective prevention and early detection. This review examines Nigeria's cancer prevention strategies and the role of public policy initiatives in addressing these challenges. It explores primary and secondary prevention measures, including vaccination programs, lifestyle modification campaigns, and screening initiatives. Additionally, it evaluates key policy interventions, such as the National Cancer Control Plan (NCCP), tobacco control regulations, and public-private partnerships aimed at enhancing cancer prevention and treatment accessibility. The review highlights existing gaps in funding, healthcare infrastructure, and policy implementation, proposing recommendations to strengthen cancer prevention through enhanced public health policies, improved healthcare access, and increased government and stakeholder collaboration. Addressing these issues is critical for reducing Nigeria's cancer burden and improving overall public health outcomes.
Background: Cervical cancer (CC) is a major non-communicable health issue in low- and lower-middle income countries, such as Uganda. Effective cervical cancer screening (CCS) and vaccination can effectively eliminate the disease as a public health issue, but these initiatives are lacking behind as CC is the most common cancer in Uganda. Future information-, screening-, and vaccinationcampaigns should be founded on a scientific depiction of the women’s understanding of the issue and solutions, to ensure a sustainable public health benefit. Methods: We performed a cross-sectional study in 5 districts of the Busoga Region of Uganda to assess rural women’s knowledge, attitudes, and practices of CC and CCS. Women ≥18 years old were included through random sampling. Data was collected using a digital questionnaire administered by trained research assistants recruited from the study area. Results are presented with descriptive statistics and logistic regression for sociodemographic predictors of KAP scores via crude and adjusted models, at a p-value of .05. Results: 585 participants were included. 57% had primary education and 83.9% were farmers. 92.1% had heard about cancer and 87.5% CC, while a minority knew of any symptoms (36.8%), risk factors (42.5%), and preventive measures (49%) of CC. Lay beliefs included poor hygiene and contraceptives as risk factors. Attitudes showed a good understanding of CC severity, preventability, and curability, and little indication of taboo. The respondent’s attitudes lacked clarity on vaccination and screening benefits as 35.6% did not know that HPV vaccination prevents CC and 24.1% did not know that screening could detect early CC. 9.1% had ever attended CCS with 12% in the 30 - 49-year-old target group. Predictors of KAP scores were identified and discussed from the perspective of similar studies. Conclusions: This study identified CC knowledge gaps in symptom awareness, risk, and preventive factors. Most women held favourable attitudes towards the disease, but less favourable towards preventive measures. Low screening prevalence indicated a need to improve public health initiatives.
Background
Cervical cancer is the leading cause of cancer deaths among women in Kenya. In the context of the Global strategy to accelerate the elimination of cervical cancer as a public health problem, Kenya is currently implementing screening and treatment scale-up. For effectively tracking the scale-up, a baseline assessment of cervical cancer screening and treatment service availability and readiness was conducted in 25 priority counties. We describe the findings of this assessment in the context of elimination efforts in Kenya.
Methods
The survey was conducted from February 2021 to January 2022. All public hospitals in the target counties were included. We utilized healthcare workers trained in preparation for the scale-up as data collectors in each sub-county. Two electronic survey questionnaires (screening and treatment; and laboratory components) were used for data collection. All the health system building blocks were assessed. We used descriptive statistics to summarize the main service readiness indicators.
Results
Of 3,150 hospitals surveyed, 47.6% (1,499) offered cervical cancer screening only, while 5.3% (166) offered both screening and treatment for precancer lesions. Visual inspection with acetic acid (VIA) was used in 96.0% (1,599/1,665) of the hospitals as primary screening modality and HPV testing was available in 31 (1.0%) hospitals. Among the 166 hospitals offering treatment for precancerous lesions, 79.5% (132/166) used cryotherapy, 18.7% (31/166) performed thermal ablation and 25.3% (42/166) performed large loop excision of the transformation zone (LLETZ). Pathology services were offered in only 7.1% (17/238) of the hospitals expected to have the service (level 4 and above). Only 10.8% (2,955/27,363) of healthcare workers were trained in cervical cancer screening and treatment; of these, 71.0% (2,097/2,955) were offering the services. Less than half of the hospitals had cervical cancer screening and treatment commodities at time of survey. The main health system strength was presence of multiple screening points at hospitals, but frequent commodity stock-outs was a key weakness.
Conclusion
Training, commodities, and diagnostic services are major gaps in the cervical cancer program in Kenya. To meet the 2030 elimination targets, the national and county governments should ensure adequate financing, training, and service integration, especially at primary care level.
Executive summary
Prostate cancer is the most common cancer in men in 112 countries, and accounts for 15% of cancers. In this Commission, we report projections of prostate cancer cases in 2040 on the basis of data for demographic changes worldwide and rising life expectancy. Our findings suggest that the number of new cases annually will rise from 1·4 million in 2020 to 2·9 million by 2040. This surge in cases cannot be prevented by lifestyle changes or public health interventions alone, and governments need to prepare strategies to deal with it. We have projected trends in the incidence of prostate cancer and related mortality (assuming no changes in treatment) in the next 10–15 years, and make recommendations on how to deal with these issues.
For the Commission, we established four working groups, each of which examined a different aspect of prostate cancer: epidemiology and future projected trends in cases, the diagnostic pathway, treatment, and management of advanced disease, the main problem for most men diagnosed with prostate cancer worldwide. Throughout we have separated problems in high-income countries (HICs) from those in low-income and middle-income countries (LMICs), although we acknowledge that this distinction can be an oversimplification (some rich patients in LMICs can access high-quality care, whereas many patients in HICs, especially the USA, cannot because of inadequate insurance coverage). The burden of disease globally is already substantial, but options to improve care are already available at moderate cost. We found that late diagnosis is widespread worldwide, but especially in LMICs, where it is the norm. Early diagnosis improves prognosis and outcomes, and reduces societal and individual costs, and we recommend changes to the diagnostic pathway that can be immediately implemented. For men diagnosed with advanced disease, optimal use of available technologies, adjusted to the resource levels available, could produce improved outcomes. We also found that demographic changes (ie, changing age structures and increasing life expectancy) in LMICs will drive big increases in prostate cancer, and cases are also projected to rise in high-income countries. This projected rise in cases has driven the main thrust of our recommendations throughout. Dealing with this rise in cases will require urgent and radical interventions, particularly in LMICs, including an emphasis on education (both of health professionals and the general population) linked to outreach programmes to increase awareness. If implemented, these interventions would shift the case mix from advanced to earlier-stage disease, which in turn would necessitate different treatment approaches: earlier diagnosis would prompt a shift from palliative to curative therapies based around surgery and radiotherapy. Although age-adjusted mortality from prostate cancer is falling in HICs, it is rising in LMICs. And, despite large, well known differences in disease incidence and mortality by ethnicity (eg, incidence in men of African heritage is roughly double that in men of European heritage), most prostate cancer research has disproportionally focused on men of European heritage. Without urgent action, these trends will cause global deaths from prostate cancer to rise rapidly.
